Epidemiologic, Public Health, and Clinical Implications of Death Among Preterm Infants in the US

In JAMA Pediatrics, Venkatesan et al share a rigorous, descriptive, epidemiologic analysis of more than 100 million US births from 1995 to 2020. The authors focus on mortality rates specifically among the more than 12 million preterm infants and highlight a few key findings. Mortality rates among preterm infants have declined substantially over the last 25 years from 33.7 to 23.3 per 1000 live births. However, inequities in preterm infant mortality persist; Black preterm infants remain 43% more likely to die than their White counterparts. Black extremely preterm infants (22-27 weeks gestation) have a small (13%) subtle survival advantage over White extremely preterm infants, which was stable throughout the study period. With respect to socioeconomic and demographic variables, infants born to individuals who smoked during pregnancy, with lower education, with inadequate prenatal care, or lacking private insurance had higher mortality rates compared with more advantaged counterparts. Additionally, improvements in infant mortality in these subgroups were smaller than more advantaged groups, resulting in widening of socioeconomic disparities in infant mortality. In this Editorial, I aim to shed light on a few key considerations when interpreting the important data presented by Venkatesan et al including the importance and implications of (1) descriptive epidemiology, (2) restriction of the data set to preterm infants only, and (3) the heterogeneity of preterm infants.